Misuse of medication can be a subtle form of abuse in aged care as it can go unnoticed easily. Staff can intentionally withhold medication and lie about why it was not given, give incorrect doses or repeat unnecessary scripts, however, there are ways to help prevent abuse surrounding medication.

The National Association of Health Authorities model for drugs and medicines within nursing homes suggests authorised pharmacists make inspections to nursing homes at least two times a year. During this visit they would inspect the methods used in the home for storing and recording drugs and ensure their tallies add up with drugs given and destroyed. This independent pharmacist also has the authority to question patients about their medications and the pharmacists who supply them (Goergen 2001, p.81)

When general practitioners visit their patients in nursing homes, they should have current records of medications so they have double check what medication is available. The nursing homes drug chart should be compared with the doctor’s records and any issues should be worked out. Changes to medications should be noted on the nursing homes side and the doctor’s side. Keeping records on the doctor’s notes and the nursing homes charts adds another level of protection for the elderly as discrepancies will be easier to pick up (Goergen 2001, p.81).

The drugs kept in the nursing homes should be patient based not stock based. This means that the pharmacists only deliver right number of drugs for the right number of patients at one time rather than a stockpile of each type of drug. This is much easier to keep track of as the drug records in the nursing home are written up by patient rather than by drug. As each dose of drug is given it is signed off and a count of doses left are kept which allow the staff to order more as required (Goergen 2001, p.83)

These are just a few ways in which safe handling of medication can be achieved, it is important to remember the more scrutiny nursing homes receive over issues surrounding their care, the less likely we are to see elder abuse occur. We can see this in Australia in recent years with the Aged Care Commission investigating the safety surrounding nursing homes.

Goergen, T 2001, Stress, Conflict, Elder Abuse and Neglect in German Nursing Homes: A Pilot Study Among Professional Caregivers. Journal of Elder Abuse & Neglect 13:1, pages 1-26.

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It is very hard to estimate the exact number of victims to elder abuse because defining who is “older” and what is abuse is problematic and additionally, due to the nature of the relationship between perpetrating carer and the victim, it is accepted that elder abuse is under reported (Moir Et al, 2017 p181).

To ensure the most appropriate and best preventative measures can be put in place, it is crucial that we have accurate and consistent parameters established to enable reliable and valid data collection. The majority of studies into elder abuse have defined “elder” as 60 or 65 and over while there is very limited research into “adults at risk” with no age limitations (Moir Et al, 2017 p181)

Age Cut-Offs are problematic for this field of research because there is no law which defines “elderly”. Current ways to operationalise ‘older’ within Australia include;

• Mature aged worker (45)
• Access to senior’s insurance (50)
• Access to superannuation (60)
• Access to senior’s care (60 or 65)
• Access to government pension (65)
• Access to aged care services (70)

It is however very important to note within the Australian context Aboriginal Australians experience a lower life expectancy as 40 – 45 is considered ‘older’.

The national research council argues that defining elderly as 65 is both over and under inclusive because there are many people over 65 who are not vulnerable and many people under 65 who are due to mental and physical disabilities, degenerative diseases and early onset dementia. In the past there have been reports of abuse from people as young as 40 who would not have been included in the definition of elder abuse (Moir Et al, 2017 p182) This is why we should move towards a model which focuses on adults at risk rather than drawing an arbitrary line in the sand which excludes people

Reference

Moir, E, Blundell, B, Clare, J, Clare, M, 2017, Best Practice for Eliminating Elder Abuse Prevalence in Australia: Moving towards the Dynamic Concept of “Adults at Risk” and away from Arbitrary Age Cut-Offs, Current Issues In Criminal Justice, Vol 29, No 2.
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Five percent of Americans in aged care facilities experience abuse & thirteen in California (Chen pg221). One of the biggest reason elder abuse continues today is under-reporting by nursing homes which is caused by victims’ inability to report due to declining cognition, physical capabilities, fear of retaliation, lack of visitors to detect abuse & a culture of silence towards abuse within facilities.

Under-staffing contributes to elder abuse, in America nursing homes are required to hire enough staff to provide 3.2 nursing hours per patient every day. The Californian Attorney General, however, reported that two out of three nursing homes inspected failed to meet this standard. This is very significant because there are approximately 17000 nursing home facilities in the United States and the expected aged population to double by 2025 (Chen p218)

Note that America does have a system in place to protect the elderly, each state has an office of the state long Term Care Ombudsman. This provides the nation with thousands of staff and volunteers who work for the ombudsmen program to provide residents and families with the long-term care, quality of life and quality of care (Chen p223)

California specifically has 35 programs run by the ombudsmen which employ people to hire, work with and train volunteers. These programs act as local ombudsmen and have the responsibility of assisting with questions and or complaints involving quality of care, fees, special diets and food, medicines and activities. In California ombudsmen have the additional task of investigating and verifying claims of abuse and neglect. This can be done because they have the right to enter nursing homes to listen and resolve complaints if deemed reasonable and necessary (Chen p223)

Despite having from what seems like a good chain to detect and control elder abuse it still exists in America at an alarming rate. It is interesting to compare America to Australia and wonder how our age care system adds up; do we spend 3.2 nursing hours with patients, does Australia’s under-staffing contribute to abuse as well and are there too many links in the chain causing a new problem?

Chen, L 2012, Eradicating Elder Abuse in California Nursing Homes, Santa Clara Law Review, Vol. 52, Issue 1 (2012), pp. 213-254
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Aging is the most significant population change projected to occur both within Australia and the world over the next 50 years. In the year 2045 Australia’s population will be made up on 25% people aged 60 and over (lacey 2014).
Elder abuse is the physical, emotional, psychological injury or risk of injury, financial exploitation, neglect to provide basic care, sexual abuse and self-neglect (stark 2018).

Possible causes of elder abuse;
Caregivers stress which is when the caregiver acts out in anger towards the elderly, many factors contribute towards stress;
• Drug and alcohol abuse
• Employment issues
• Low income
• Increased risk of falls
• Incontinence
• Verbal and physical aggression
• Poor caregiver skills

Trans-generational Violence
Trans-generational violence supports the assumption that abuse is learned behaviour passed down between generations therefore a child who was raised by an abusive parent may then become the abuser when caring for the same parent.

Prevention
There are several things elderly people can do to prevent abuse;
• Maintaining a social life
• Keep in touch with friends when moving into care
• Organising weekly cheek ins
• Having people over to visit
• Maintain their own mail
• Have their own phone
• Maintain their own finances

Diagnosis
Diagnosis can be very difficult due to dementia or caregivers explaining injuries due to dementia. Physical signs of abuse could include bruises, lacerations, broken and/or fractured bones, untreated injuries, dislocations, medication overdose and under utilisation.
Verbal assessments may also be used by health care professionals in order to diagnose abuse, questions that could be asked may include;
Has anyone at home ever hurt you?
Has anyone ever touched you without your consent?
Has anyone taken anything that was yours without asking?
Has anyone ever threatened you?
Have you ever signed any documents that you didn’t understand, or you didn’t want to sign?
Are you afraid of anyone at home?
Are you alone a lot?
Has anyone ever failed to help you take care of yourself when you needed help?

Lacey, W 2014, ‘Neglectful to the Point of Cruelty; Elder Abuse and the Rights of Older Persons in Australia’, Sydney Law Review, no. Issue 1, p. 99, viewed 20 April 2019, <https://search-ebscohost-com.ezproxy.uow.edu.au/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.sydney36.7&site=eds-live&gt;.

Stark, SW 2018, ‘Elder abuse’, Salem Press Encyclopedia of Health, viewed 18 May 2019, <https://search-ebscohost-com.ezproxy.uow.edu.au/login.aspx?direct=true&db=ers&AN=93871903&site=eds-live&gt;.
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